医疗保健中的合作生产:说辞与实践

Co-production in healthcare:rhetoric and practice

医疗保健的合作生产正受到越来越多的关注,然而,人们仍然不甚了解合作生产的过程。本文探讨了医院使病人与医护人员参加合作生产活动的原因及实践中医院对合作生产的体验。我们对五家荷兰医院进行了定性研究,包括半结构化访谈(27人)、观察(70小时)及文档分析,病人和医护人员都参与其中以改善服务。研究结果表明,各家医院使病人和医护人员参加活动的动机不同,且都调整了现有方法来让病人参与。令人关注的是,病人提出需要改进的地方通常是已知的,但合作生产过程的确以另外的方式促进质量改进。合作生产过程激发医院思考如何实现质量改进。这一过程推动了质量改进,因为看到病人并听到病人的体验使医护人员产生了一种紧迫感,促使他们对病人提出的问题采取行动。此外,这些体验使高级管理机构的改进变得合理化。

Co-production in healthcare is receiving increasing attention;however,insight into the process of co-production is scarce.This article explores why hospitals involve patients and staff in co-production activities and hospitals’experiences with co-production in practice.A qualitative study with semi-structured interviews(N=27),observations(70 hours)and document analysis was conducted in five Dutch hospitals,which involved patients and staff in order to improve services.The results show that hospitals have different motives to involve patients and staff and have adapted existing methods to involve patients.Interestingly,areas of improvement proposed by patients were often already known.However,the process of co-production did contribute to quality improvement in other ways.The process of coproduction stimulated hospitals’thinking about how to realize quality improvements.Quality improvements were facilitated by this process as seeing patients and hearing their experiences created a sense of urgency among staff to act on the improvement issues raised.Moreover,the experiences served to legitimatize improvements to higher management bodies.